D.C. Pioneers Breastfeeding Rights In U.S.

A historic piece of women's rights legislation is pending before the City Council of Washington, D.C. Known as the Infant Feeding Rights Act, the legislation represents the first effort in the U.S. to implement the World Health Organization/UNICEF Code of Marketing of Breastmilk Substitutes.

The bill would give women the right to be free from "undue commercial influence," such as free samples of formula and literature from infant formula companies. It also seeks to reform hospital procedures that interfere with a mother's opportunity to initiate breastfeeding in the hours and days following delivery.

Sponsored by 11 of the 13 City Council members, the bill has garnered wide support from the D.C. chapter of the Infant Formula Action Coalition, the D.C. Nurses Association, and various consumer and women's organizations. It is opposed, however, by medical professional associations and the infant formula industry.

Based on recommendations by the American Academy of Pediatrics, the bill requires that hospital procedures be changed to:

• ensure a woman's right to breastfeed as soon after delivery as possible;
• permit sedation during childbirth only with the woman's informed consent;
• allow infants to feed on demand without supplementary bottle feedings;
• allow mothers free access to infants to facilitate demand feeding; and,
• permit the administration of lactation suppressants to a woman only with her informed consent.

In addition, the bill provides that prospective mothers be informed of these rights as early in pregnancy as possible, but emphasizes that none of the rights preclude other feeding methods that might be required by a medical condition in either the mother or the infant.

Praising the legislation before a D.C. Council committee, the D.C. Commission on Women called it "one of the most far reaching, progressive pieces of legislation, both nationally and internationally, on the merits of breastfeeding. It could very well serve as a model for other states and countries."

The bill's supporters point out that such legislation is needed in the United States because hospital procedures are inconsistent and often work to undermine a woman's decision to breastfeed. Routine hospital bottle feedings of water, glucose water, and formula interfere with the infant's hunger cycle, and thus with the natural pattern of frequent feedings (at least eight or nine times in 24 hours).

Dr. Audrey Naylor, Director of the Lactation Program at the University of California, San Diego, testified before the committee that it is biologically possible for 95 percent of mothers to produce sufficient milk for their infants. "Most nursing failures are the direct result of incorrect information ... and of hospital procedures which interfere with normal breast physiology," she said.

She concluded that "it is totally inappropriate to provide discharge packs of formula to breastfeeding families. The non-verbal message is one of doubt at a time when confidence is most critical. Patients presume that something given by a health professional is to be used. The discharge pack promotes formula sales, not successful breastfeeding."

Opponents of the bill say that it would not reduce the infant mortality rate in the District of Columbia, but could interfere with "physician prerogatives," and with the privileged doctor/patient relationship. They also argue that the legislated policy changes would be costly to implement and difficult to enforce and that they would legislate breastfeeding. Charlene Drew Jarvis, the Council member who introduced the bill, was skeptical of these arguments, which were presented at the committee hearing. She reminded opponents that the bill was not designed to require breastfeeding, nor to substantially reduce the infant mortality rate, but "to allow women who choose breastfeeding to do so without obstacles."

Dr. Dennis O'Leary, President of the D.C. Medical Society, conceded that "there are some unintended obstructive practices at hospitals, and no one is going to tell you differently." But he contends that the benefits of the proposed law would be outweighed by costs of excessive paper work, higher health costs, and increased litigation. The bill remains in committee, while staff members collect data and information from the 13 D.C. hospitals on their infant feeding procedures. The D.C. Council does not expect to vote on the bill for several weeks.

Fred Clarkson, a freelance writer based in Washington, D. C., was formerly a member of the D. C. chapter of the Infant Formula Action Coalition.